2026 Volume 7 Issue 1 Pages 76-80
The Lapidus procedure is a surgical option for hallux valgus that typically employs either intramedullary nails or plates for internal fixation. Here, we present a case in which intraoperative complications associated with an intramedullary nail and subsequent skin compromise from plate fixation were managed using negative pressure wound therapy (NPWT). The patient was a 90-year-old woman on dialysis who was referred for hallux valgus correction. During surgery, the intramedullary nail shifted substantially within the bone during insertion. Stable fixation was considered unachievable; therefore, we converted to plate fixation. Postoperatively, the patient had dorsal foot and second toe congestion with discoloration that progressed to superficial black necrosis. After debridement and initiation of NPWT, the second toe tip eventually detached, and epithelialization was achieved by 3 months. Although the procedure was initially planned with consideration of the patient’s bone and soft-tissue fragility, intraoperative troubles necessitated plate fixation. We hypothesize that the combined effects of soft-tissue insult from plating and dialysis-associated circulatory impairment led to skin necrosis, with additional contributions from toe wire fixation, prolonged operative time, and bulky bandaging. Preoperative assessment of bone strength and blood flow combined with tailored perioperative management may reduce complication risk in such patients.
